Breastfeeding: Latching On with the Community

Objective: To describe the early breastfeeding experience at one institution and identify lactation concerns before and after discharge.

 Design: The study is a prospective cohort observational design. Fifty mothers were identified of 200 births in a systematic screening with every 4^th mother enrolled. Four were excluded due to multiple gestation or Level 2 care. Ten chose to feed infants artificial milk. Three declined participation resulting in 33 subjects.

 Setting: Participants were admitted to Level I care at a 550 bed tertiary care hospital with Level 2 Maternal/Infant Care and 3200 deliveries/year.

Patients/Participants: Mothers had a median age of 29.5 years, 88% had some college education, and 51% were primiparous. The average breastfeeding rate of the institution was 78%. Mothers had a high intent to breastfeed without the use of formula for at least the first month (91%) with a gradual decrease to 45% by 6 months.

Methods: Subjects were interviewed and had a formal breast feeding evaluation by an International Board Certified Lactation Consultant (IBCLC) 24-48 hours after birth. The IBCLCs were responsible for collection of data from the mother, assessment of the couplet, including breastfeeding factors, in the immediate postpartum period. Maternal perception of lactogenesis II was evaluated during a structured telephone interview 72-96 hours post delivery. Participants were asked if they had breastfeeding concerns and if evaluation, including plan of care had been provided.

 Results: Only 45% reported a concern related to breastfeeding prior to discharge; however, more (67%) had concerns after discharge. Concerns included: milk volume (36%), positioning and attachment to the breast (48%), and nipple/breast pain (55%). Only 18% of mothers reported breast fullness while hospitalized, while 91% had reported fullness at the time of the follow up telephone interview. Only 3% of the participants received formal breastfeeding evaluation after discharge from the hospital.

 Conclusion/Implications for nursing practice: Results of this study provide a profile of breastfeeding rates and concerns which support the need for development of an outpatient, hospital-based lactation program. Mother’s needs were greater at days 3-5 post birth than prior to discharge. The outpatient program will be designed to provide the following services: physical assessment of mother and infant by an IBCLC, infant feeding evaluation, education related to normal infant behavior, support in parenting skills, and access to rental of hospital-grade breast pumps. These results provide a profile that will be useful for interventional studies.

Keywords:  lactation, maternal breastfeeding concerns, outpatient lactation follow-up